Contents
1 Aim
All community trial without catheters (TWOC) will be performed by the specialist continence service. While the community hospital wards should attempt to perform a TWOC before discharging patients’ home with a urinary catheter.
The specialist continence service will receive referrals from acute trusts, GP’s and other healthcare professionals for patients requiring a trial without catheter in the community.
The rationale behind this procedure is to:
- reduce avoidable hospital readmissions
- enhance patient care
- ensure that indwelling urinary catheters are removed at the earliest and safest opportunity
2 Scope
This manual applies to all clinical staff working in the Doncaster care group of RDaSH who deliver or provide continence or catheter care to adult patients over the age of 18. For staff working in Rotherham and Scunthorpe, they will need to refer to their local guidelines
It is recognised that primary care practitioners are also part of the organisation and as such this policy is offered for use by them to adapt to their own practices and organisations as appropriate.
The author of the policy is available to offer help and support to primary care practitioners who wish to use and implement this policy.
As part of good employment practice, whilst undertaking work for RDaSH. agency workers are also required to abide by the RDaSH policies and procedures, as appropriate, to ensure their health, safety and welfare.
Adherence to the procedures within this manual is the responsibility of all trust staff, including agency, locum and bank staff.
3 Link to overarching policy
3.1 Links to associated documents
3.2 Links to relevant policies or procedures
4 Procedure
4.1 Trial without catheter
TWOC is the term used when a catheter has been inserted via the urethra into the bladder for drainage purposes, and is removed to determine whether the patient is able to pass urine safely and spontaneously without the need for further catheterisation
4.2 When to refer a patient to the specialist continence service for a TWOC
When a catheter is already being used the Healthcare practitioner should consider if it is necessary. This can be established using the HOUDINI indicators which lists clinical indications when it is appropriate for the continued use of a catheter, (Adams et al, 2012).
HOUDINI:
- H, haematuria, only requires catheter if in clot retention
- O, obstructed or retention
- U, urologic surgery
- D, decubitus ulcers, open sacral or perineal wound in an incontinent patient
- I, input or output, fluid monitoring
- N, not for resuscitation, end of life or comfort care
- I, immobility due to physical constraint, for example unstable fracture and inability to use bottles or bedpans
If none of the above criteria are met, please complete the TWOC referral form for the specialist continence service to arrange a community TWOC.
4.3 Exclusion criteria
- Lacks capacity to consent then a best interest decision may be appropriate after a discussion with the patients general practitioner and or identified advocate.
- Unable to measure and record fluid in and output or does not have carer support.
- Unable to or has no carer support to make contact by telephone to single point of access.
4.4 Considerations
Consideration should be given to patients who present with:
- constipation, should be treated with appropriate bowel management medication prior to removal of the catheter
- symptomatic urinary tract infection (not just positive urinalysis). Treat the infection ensuring treatment is successful before community TWOC
4.5 Contraindications
- Radical prostatectomy within 3 months.
- Patients who experience significant problems with catheter insertion (require multiple attempts by a consultant or additional instrumentation to place the catheter, history of haemorrhage in previous catheterisations).
- Patients who withhold consent for TWOC in the community.
5 Appendices
Please see continence manual webpage for appendices attached to this procedure.
- Appendix D Protocol for community trial without catheter by the specialist continence service
- Appendix E Protocol for community hospital wards performing a trial without catheter (TWOC)
Document control
- Version: 2.
- Unique reference number: 505.
- Date ratified: 6 September 2022.
- Ratified by: Clinical policies review and approval group.
- Name of originator: Senior continence specialist sister.
- Name of responsible individual: Executive director of nursing and allied health professionals.
- Date issued: 20 September 2022.
- Review date: September 2025.
- Target audience: All clinical staff within Doncaster group.
- Description of change: No change to procedure.
Page last reviewed: April 24, 2024
Next review due: April 24, 2025